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NPI Code Detail

MEDICARE: MEAGHAN ALLYCE BOLGER D.D.S.

MEDICARE: MEAGHAN ALLYCE BOLGER D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2122300000XDentist057884NY

General Provider Information

NPI Number : 1023420908
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEAGHAN ALLYCE BOLGER D.D.S.
Provider Business Mailing Address
First Line : 97 WESTFIELD RD
Second Line :
City : AMHERST
State : NY
Zip : 14226-3492
Country : US
Telephone Number : 716-480-9819
Fax Number :
Provider Business Practice Location Address
First Line : 2896 GRAND ISLAND BLVD
Second Line :
City : GRAND ISLAND
State : NY
Zip : 14072-1251
Country : US
Telephone Number : 716-773-7074
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2014
Last Update Date : 10/28/2016

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